膽管癌外科治療課件整理

膽管癌外科治療的奧踐和存在問題的探討膽管癌外科治療的奧踐1概Biliaryductcancer/Cholangiocarcinoma定義:發(fā)生于肝外膽管(含左右肝管主干至膽總管下端)惡性腫瘤的總稱。不包括肝內(nèi)膽管癌、肝臟膽管細胞癌、膽囊癌、乏特壺腹癌發(fā)生部位:上段膽管瘟中段膽管癌下段膽管癌概2爭論Figur1:ClaasiseationofChelangieesreinema源于膽管上皮的惡性腫瘤—膽管癌(含肝內(nèi)、肝外膽管癌侵RepooucecwinpensiontrumPatelT-Choancarcnoma,hacinPactGasl0aL20063134及肝門部膽管)●Intra-hepaticCholangiocarcinomaExtra-hepaticCholangiocarcinoma爭論3流行病學資料6os--70sBileductcancer=3,000/yrHighestincidenceineGallBladdercancer=6,goo/yJapan,Israel,andNativeamericansHepatocellularCa=15,ooo/yr●IncreasedintheUSA●M/F=3/2Rightorlefthepaticduct%●Bifurcation=20%USMazenhassanainmd●Proximalcbd=30%手術(shù)切除率10%DistalCBD=30%流行病學資料4病因?qū)W資料病因未明多病因高危因素膽管結(jié)石膽道蛔蟲膽管炎癌中華分枝睪吸蟲先天性膽管囊狀擴張癥■→》癌(癌變率達25%~15%)病因?qū)W資料5膽管癌治療與臨床指南美國癌癥聯(lián)合會NCCN●歐洲腫瘤醫(yī)學會EMSO英國肝臟病協(xié)會BASL其他NHSHospitalguidline膽管癌治療與臨床指南6CietprehenaiveNCCNGuidelinesVersion2.2012Newark.ExtrahepaticCholangiocarcinomaFRMARYTREATMENTnignotprimiidneghemgradirasion'R→3SurveillaneEXTRA2)CietprehenaiveNCCNGuidelines7clinicalpracticeguidelinesofOncolgy21Pupplamant5:ve5-v692010Biliarycancer:ESMOClinicalPracticeGuidelinesfordiagnosis,treatmentandfollow-upF.Eckel.TBrunner&SJelicOnbehalfoftheESMOGuidelinesWorkingGrouKwwkrnecusaatMnwch,Gman"GraysnareafAaaaOnmgyanEaagyyofOxydChuc/MHosp!.hamadMer/chgSar/oBnstituteorOncologya,B電aSet圖inecidenceaparoscopy.UpperandlowerendoscopyhastobeperformeThecrudeincidenceafgallbladderandextrahepaticbiliainpatientswithanisolatedintrahepaticmass.Thestagingiscancer(ICD-10:C23-C24)intheEuropeanUnionis3.2ordingtatheTNM2010systemseratelyfor[Table1),intrhepaticcholangiocarcinomaand-5.4/10000peryearformalesandfemales,respectively.(Table2a).perhilarcholangiocarcinoma(Tabke2b),anddistalge-adjustedmortalityis1.4and1.9/100DO)formalesandcholangiocarcinoma(Tableze)HilarcholangiocarcinomaoLangiocarcinoma(ICD-10.C22isincreasingandmaybeinvolvementofthehepaticductsaccordingtotheBismuth-matedas0,9-1.3and0.4-0.7/100000formalesandales,respectively,as10%r-15%ofprimarylivercanICD-10:C22).Inhigh-riskareasinEurope(southItaly)incidenceisestimatedatupto4.9-7.4and-2.9-4.3/100000treatmentafterincidentalfindingofclinicalpracticeguidelines8GUIDELINESGuidelinesforthediagnosisandtreatmentofcholangiocarcinoma:consensusdocumentBRDavidson,RGoldin,SPPerelMCRosenbergas,MRThurs.HWasanclchalangioarcimaeIheneellBileductadenomaandbiliarypauillomalosiCarali'sdiseasecysticdilatationcrdut,lifctimericE73).cysts(aboutswilltransform.withage)helorethetinaldeciesSmokingincreasedriskinassocitionwithPsC)erethetumourcntheassnlwerIlukes-opIiwvE/urwITweandCNE/Ni3/N2515chronictyphoidcarriarixtokinucaxdrikofallhepatobiliarymalignancvidenceawailable(action2.1.3ContextandintentTheseguidelinesarcinkndcdtobringsomitcneyandasinclusiveofiniEhepatEPlGUIDELINES9ssuedate:July2005NHSNationalInstituteforHealthandClinicalExcellencePhotodynamictherapyforbileductcancerGuidance1.2Treatmentoptionsdependonthestage,size,1Currentevidenceonthesafetyandefficacyofpositionandtypeottumour.Bleductcancerisphotodynamictherapy(PDI)farbileductcancernotusualbydiagnosedbeforethesymptomsofesnotappearadequateforthisproceduretoliarobstructionoccur,bywhichtimethebeusedwithoutspecialarrangementsforcorermaybetooadvancedforcurativesurgiGaandforauditorresearchresection.OptionsforpalliatvetreatmentincludeurgicalbypassofthebileductortheinsertionofancershouldtakethefollowingactionsnformtheclinicalgovernanceleadsintheirTrustshemotherapyandbrachytherapyarestillbeingssuedate:July200510膽管癌外科治療課件整理11膽管癌外科治療課件整理12膽管癌外科治療課件整理13膽管癌外科治療課件整理14膽管癌外科治療課件整理15膽管癌外科治療課件整理16膽管癌外科治療課件整理17膽管癌外科治療課件整理18膽管癌外科治療課件整理19膽管癌外科治療課件整理20膽管癌外科治療課件整理21膽管癌外科治療課件整理22膽管癌外科治療課件整理23膽管癌外科治療課件整理24膽管癌外科治療課件整理25膽管癌外科治療課件整理26膽管癌外科治療課件整理27膽管癌外科治療課件整理28膽管癌外科治療課件整理29膽管癌外科治療課件整理30膽管癌外科治療課件整理31膽管癌外科治療課件整理32膽管癌外科治療課件整理33膽管癌外科治療課件整理34膽管癌外科治療課件整理35膽管癌外科治療課件整理36膽管癌外科治療課件整理37膽管癌外科治療課件整理38膽管癌外科治療課件整理39膽管癌外科治療課件整理40膽管癌外科治療課件整理41膽管癌外科治療課件整理42膽管癌外科治療課件整理43膽管癌外科治療課件整理44膽管癌外科治療課件整理45膽管癌外科治療課件整理46膽管癌外科治療課件整理47膽管癌外科治療課件整理48膽管癌外科治療課件整理49膽管癌外科治療課件整理50膽管癌外科治療課件整理51膽管癌外科治療課件整理52膽管癌外科治療課件整理53膽管癌外科治療課件整理54膽管癌外科治療課件整理55膽管癌外科治療課件整理56膽管癌外科治療課件整理57膽管癌外科治療課件整理58膽管癌外科治療課件整理59膽管癌外科治療課件整理60膽管癌外科治療課件整理61膽管癌外科治療課件整理62膽管癌外科治療課件整理63膽管癌外科治療課件整理64膽管癌外科治療課件整理65膽管癌外科治療課件整理66膽管癌外科治療課件整理67膽管癌外科治療課件整理68膽管癌外科治療的奧踐和存在問題的探討膽管癌外科治療的奧踐69概Biliaryductcancer/Cholangiocarcinoma定義:發(fā)生于肝外膽管(含左右肝管主干至膽總管下端)惡性腫瘤的總稱。不包括肝內(nèi)膽管癌、肝臟膽管細胞癌、膽囊癌、乏特壺腹癌發(fā)生部位:上段膽管瘟中段膽管癌下段膽管癌概70爭論Figur1:ClaasiseationofChelangieesreinema源于膽管上皮的惡性腫瘤—膽管癌(含肝內(nèi)、肝外膽管癌侵RepooucecwinpensiontrumPatelT-Choancarcnoma,hacinPactGasl0aL20063134及肝門部膽管)●Intra-hepaticCholangiocarcinomaExtra-hepaticCholangiocarcinoma爭論71流行病學資料6os--70sBileductcancer=3,000/yrHighestincidenceineGallBladdercancer=6,goo/yJapan,Israel,andNativeamericansHepatocellularCa=15,ooo/yr●IncreasedintheUSA●M/F=3/2Rightorlefthepaticduct%●Bifurcation=20%USMazenhassanainmd●Proximalcbd=30%手術(shù)切除率10%DistalCBD=30%流行病學資料72病因?qū)W資料病因未明多病因高危因素膽管結(jié)石膽道蛔蟲膽管炎癌中華分枝睪吸蟲先天性膽管囊狀擴張癥■→》癌(癌變率達25%~15%)病因?qū)W資料73膽管癌治療與臨床指南美國癌癥聯(lián)合會NCCN●歐洲腫瘤醫(yī)學會EMSO英國肝臟病協(xié)會BASL其他NHSHospitalguidline膽管癌治療與臨床指南74CietprehenaiveNCCNGuidelinesVersion2.2012Newark.ExtrahepaticCholangiocarcinomaFRMARYTREATMENTnignotprimiidneghemgradirasion'R→3SurveillaneEXTRA2)CietprehenaiveNCCNGuidelines75clinicalpracticeguidelinesofOncolgy21Pupplamant5:ve5-v692010Biliarycancer:ESMOClinicalPracticeGuidelinesfordiagnosis,treatmentandfollow-upF.Eckel.TBrunner&SJelicOnbehalfoftheESMOGuidelinesWorkingGrouKwwkrnecusaatMnwch,Gman"GraysnareafAaaaOnmgyanEaagyyofOxydChuc/MHosp!.hamadMer/chgSar/oBnstituteorOncologya,B電aSet圖inecidenceaparoscopy.UpperandlowerendoscopyhastobeperformeThecrudeincidenceafgallbladderandextrahepaticbiliainpatientswithanisolatedintrahepaticmass.Thestagingiscancer(ICD-10:C23-C24)intheEuropeanUnionis3.2ordingtatheTNM2010systemseratelyfor[Table1),intrhepaticcholangiocarcinomaand-5.4/10000peryearformalesandfemales,respectively.(Table2a).perhilarcholangiocarcinoma(Tabke2b),anddistalge-adjustedmortalityis1.4and1.9/100DO)formalesandcholangiocarcinoma(Tableze)HilarcholangiocarcinomaoLangiocarcinoma(ICD-10.C22isincreasingandmaybeinvolvementofthehepaticductsaccordingtotheBismuth-matedas0,9-1.3and0.4-0.7/100000formalesandales,respectively,as10%r-15%ofprimarylivercanICD-10:C22).Inhigh-riskareasinEurope(southItaly)incidenceisestimatedatupto4.9-7.4and-2.9-4.3/100000treatmentafterincidentalfindingofclinicalpracticeguidelines76GUIDELINESGuidelinesforthediagnosisandtreatmentofcholangiocarcinoma:consensusdocumentBRDavidson,RGoldin,SPPerelMCRosenbergas,MRThurs.HWasanclchalangioarcimaeIheneellBileductadenomaandbiliarypauillomalosiCarali'sdiseasecysticdilatationcrdut,lifctimericE73).cysts(aboutswilltransform.withage)helorethetinaldeciesSmokingincreasedriskinassocitionwithPsC)erethetumourcntheassnlwerIlukes-opIiwvE/urwITweandCNE/Ni3/N2515chronictyphoidcarriarixtokinucaxdrikofallhepatobiliarymalignancvidenceawailable(action2.1.3ContextandintentTheseguidelinesarcinkndcdtobringsomitcneyandasinclusiveofiniEhepatEPlGUIDELINES77ssuedate:July2005NHSNationalInstituteforHealthandClinicalExcellencePhotodynamictherapyforbileductcancerGuidance1.2Treatmentoptionsdependonthestage,size,1Currentevidenceonthesafetyandefficacyofpositionandtypeottumour.Bleductcancerisphotodynamictherapy(PDI)farbileductcancernotusualbydiagnosedbeforethesymptomsofesnotappearadequateforthisproceduretoliarobstructionoccur,bywhichtimethebeusedwithoutspecialarrangementsforcorermaybetooadvancedforcurativesurgiGaandforauditorresearchresection.OptionsforpalliatvetreatmentincludeurgicalbypassofthebileductortheinsertionofancershouldtakethefollowingactionsnformtheclinicalgovernanceleadsintheirTrustshem